A blog about process improvement for staff and managers at Clackamas County Health, Housing & Human Services

May 20, 2013

Over (9) Lean improvements were presented at the County Quarterly Manager Meeting (QMM) in April. Seven of the presentations were from staff which had recently completed their Lean training at Clackamas Community College. As part of their course work they were required to complete a Lean project.

H3S was asked to present 2 of our recent improvement activities. We chose the rapid process improvements (RPI) for Transportation Reaching People in Social Services and the Phone Call Center in the Health Center Division

The team members did an outstanding job working on these improvement activities developing the process changes to deliver the projected improvements for each activity.

Volunteer Connections-Transportation Reaching People

Robyn Hoffman and Galina Burley presented for the Social Service Division on the Transportation Reaching People rapid process improvement.

Team Members

Eileen Collins

Pegg Husman

Betty Lou Ross

Jim

Galina Burley

Lean facilitators

Robyn Hoffman

Amy Cleary

Projected Improvements

Phone lines 3 to 1

Staff time savings 10 min per client by eliminating steps

Reduced printing by 35 sheets per day

Additional staff time savings of 3 hours per month

Health Centeter - Phone RPI

Also presenting for the Health Center Division were Leslie King and Jo Hobbs on the Primary Care Health Center phone rapid process improvement activity.

January 9, 2013

One of the first improvements the Behavioral Health Clinic’s Lean improvement team decided to take on was how clinical staff was notified when a client has arrived for their appointment. Once a client was checked-in by the support staff they would call the clinical staff usually leaving a voice mail telling the clinical staff that their next appointment was in the waiting room.

This process caused several inefficiencies such as:

Difficulties communicating from support to clinical when clients were arriving.

Support staff experienced some waste by having to leave a 10 second recorded message. (required by our voice mail system)

Time consuming for clinicians to check their messages to see if their next appointment had arrived.

Voicemails queue up in the system, so clinician would have to listen to all of the messages in the queue to get to the message about their next appointment.

The team decided to give instant messaging a try. In less than 30 days the instant messaging“Sparks” was implemented for use in the clinic. The other noteworthy thing about this improvement is that there was unanimous agreement about implementing IM for this purpose across programs!

Support
staff now sends an instant message to the clinical staff when their next client
is ready, the message pops up on their computer and remains on the computer
until closed by the clinician.

The benefits for staff are:

Eliminating waste for the support staff, no 10 second voice mail.

Improved communication between support and clinical staff.

Less disruptions during an appointment caused by the phone ringing about their next appointment

Clinician no longer having to listen to a queue of voice mails to find out if their next appointment is ready

An unexpected benefit from this process change was the following comment from aclinician.

“In the past I was never sure when the front desk was calling if it was a routine call to inform me that my next client was here, or if it was an urgent matter. Now I know when the front desk calls that it is likely an urgent matter, or even better, they can inform me briefly what’s going on through IM and I can best assess how to handle it.”

December 5, 2012

I recently moved into a smaller office space. This required getting rid of a lot of historic files, and binders full of completed project information. If I had been more Lean along the way, many of these files would already have been purged , saving yet one more round of lifting and shifting , reorganizing and piling. How many times have I moved offices since being hired in 1998…? Many of those original files were still with me.

I have been with the county over 14 years, inheriting files from a previous supervisor. Those files contained information that was nostalgic, but not necessary for our current service delivery. Even with file retention policies, and the ability to get rid of these files over time, I kept hanging on to them,

5S'ing has allowed me to let go. I reminded myself of the guidelines that help us keep our work stations Lean: Have I used this in the last year? Is this information that will ever be looked at in the future? Would it be worth the time it would take to scan the information for archiving?

Once I decided to dump the old files, I began tearing them apart by hand, taking out all of the paper clips and metal prongs. The confidential information was stuffed into the shred bin. This was taking time. So some volunteers pitched in and helped clean out a few file boxes for us. Then, I learned something new from an administrative assistant - the Shred Guys will come pick up whole boxes of confidential files, paperclips and all, and haul them off. I didn't know there was a new and better way to purge ourselves of outdated case files! What a shock! I had been wasting time, at the same time I was 5S'ing! How ironic.

The move is complete now. The new office is much more organized, and old habits are being replaced by new electronic filing practices. It is a relief to not be surrounded by outdated files and materials. The computer and scanner are taking the place of folders and paperclips. The next step will be to fine tune the filing and purging practices for those electronic files. But at least you can't see them piled up on my desk top.

October 31, 2012

It is time to introduce you to our latest freshly-minted batch of Leanfacilitators. 11 H3S staff members volunteered for Lean training earlier thisyear. They have now completed training and are ready to assist each of ourDivisions in improving operations and applying the principles of Leanmanagement to our work.

When we started our Lean journey three years ago our Lean facilitators were nottasked with doing process improvements within their respective Division.Instead, they only did process improvements and Lean projects with Divisionsother than their own. After assessing the results of our initial Lean efforts,we believe having facilitators with a deeper knowledge of the specificoperations of the Division they are working with will further enhance ourimprovement activities. Because of this, the new class of Lean facilitatorswill work within their respective Divisions. This will help ensure that Leanfacilitators are able to use their relationships, knowledge, and skills toimprove processes within each Division.

Each Lean facilitator received over 20 hours of class work and training on Leanprocess improvement techniques, as well as how to lead and facilitateactivities. They are now ready to assist you in identifying ways to improve howwe deliver services. We all can identify things large and small that slow usdown, make our work more difficult, and interfere with focusing on servingpeople in need in Clackamas County.

I want to thank all of our new Lean facilitators for their service. I am reallylooking forward to seeing what great projects you all come up with for them toassist you with.

So,
without further ado, we are very happy to introduce our H3S lean facilitators.

October 10, 2012

Sometimes improvement to our process can happen very quickly. We don’t always need to have multiple meeting to improve processes. Sometimes all it takes is getting the right people talking to each other.

Below is an example of a problem that was solved with 6 short emails in one morning.

Problem statement:Staff no longer employed by county still on email distribution lists

Emailfrom Leon Rohrer-Heyerly To Paula Jack 9/12 6:28

Paula, do you have any idea why the employees who no longer work here did not get removed? Is there a missing step?

Emailfrom Leon Rohrer-Heyerly to Lean Team 9/12 6:34PM

Once a staff leaves or comes to the county there always seems to be glitches with getting them added to email groups and getting them removed. Today I am dealing with 3 staff who no longer work here yet have email accounts.

Gathering Data

Paula emails to Leon 9/13 8:07am

A PA should generate requests for these employees to be completely removed from the network including email distribution groups.

Root Cause Analysis

Email to Leon, Paula, and BH lean team 9/13 11:42am

Marco stated that it is up to the supervisor’s to let him know when someone has left the county. He then removes them from the distribution list he has access to, mainly the old community health directories (PH, BH, PC). Some supervisors notify Marco, some do not.

Erin when notified of someone leaving the county via the PA, emails Jim Bauer, Kimberly Hebbard, and Karen(phones) about the individual.

Recommended Solution

Erin did state she could also copy Marco Enciso on the email as a way of notifying him to remove the individuals from the distribution list.

Solution Implemented

Email from Erin to Leon, Paula, and BH lean team 9/13 11:44am

I think that would work great! (referring to adding Marco to the email to remove individuals for the distribution list)

October 3, 2012

A visual workplace converts information into simple and easily understood visual devices that are installed exactly where people need them. Such devices make it easier to get things done, communicates what needs to be done, reduces errors, and boosts morale. A visual workplace will also tells us when our processes are veering off course and allow us to proactively take action to stabilize our processes before they impact our customers, clients, patients, or families.

Every day examples of Visual Management

In any language the shape and color tells us what to do.......STOP

Traffic signs tell us where we are going, direction, and when to exit.

How each program does visual management within their programs will be unique to the work done in the programs. Be creative and experiment to find what works for your team.

Examples of Visual Management at H3S

A list of tasks scheduled by week. The color of the post-it identifies who is doing the task. A simple communication tool for staff and management.

The Min/Max location tell staff at the clinic when to restock towels,(reached the Min line) and how many to restock.(no more the Max line)

The colored flags tell CMA, Providers, and RN at the clinic who needs to see the patient next and status of patient.

School exclusion immunization workload calendar. Every day the team needed to complete 310 records in order to meet the 3 week deadline for getting school exclusion letters out to parents. By tracking actual records processed each day the team was able to adjust workloads to insure completion of all record before the deadline.

September 19, 2012

The ingenuity of man knows no bounds. What we choose to focus that on is the only real boundary.

What would happen if we decided to look at our processes to see if there are any new options to try? Are our processes running at their optimal performance? Can we tweak it to make it better? Does every process really need to be looked at? Do we really need to look at processes again and again? Shouldn’t we focus on new improvements? What would happen if we looked at something we already fixed and tried something new?

As Lean is now a H3S standard we need to learn to capitalize on what Lean can give us. What can Lean give us? Time. In actuality Lean gives us more than that but in my opinion time is the most valuable.

It increases capacity without having to work harder. If you are able to implement an improvementand stick to the future state or best method that was created you will usually be able to do the same amount of work in less time, or at least less frustration and that means you can accomplish more in your work day. That is the benefit of looking for improvements and these improvement opportunities are all around us. While it is important to find and focus on new ones, it is essential that we review what we have done, how it has fared and what new changes can be made to improve the improvement.

Why look again? Our options and our choices might have changed. Why, becausecircumstances, policies, personnel, requirements, environment, necessity, and technologyrarely stay the same. Maybe the urgency of the process has changed, requiring certain steps to be done in a different order, or on a tighter timeframe. Maybe the requirements around the process have changed and now are no longer as stringent allowing you new options that were unavailable before. Maybe you now have access to software that gives you new tools that were not available the first time you worked on the process. Maybe you have new staff, with a different point a view and new ideas that were not thought of before. Maybe you review the process completely andconclude that it is still the best way to do business. If that is the case, at least you still knowyou are doing it the best way.

As my good friend has always said “Maybe not every process can be improved upon but every process deserves a second look.”

August 8, 2012

Children Youth and Families (CYF) continues to improve 5S efforts that began over a year ago. The department has come up with the following to keep the focus on continuous improvements.

Sustaining Activities:

A bin is placed near the printer/copier to collect stray papers for review and retrieval by staff with 24 hours of printing. Items left more than 24 hours will be recycled.

Extrapaper stock is donated to local non-profits.

Scanning will be implemented to reduce paper files..

Work Agreements:

Staff agree to help put new supplies away in designated locations.

A 5S Check List is customized for CYF work space. This tool is used monthly to assess how the sustaining plan is working. One staff person (i.e., the meeting facilitator for that week) uses the 5S Check List to assess the state of work areas prior to a designated monthly meeting (i.e., the first Tuesday of every month). The facilitator includes discussion of the check list on the staff meeting agenda.

Before Current

The next project CYF has taken on involves organizing files within the cabinets in their file room. Look for that process in a future Lean Blog.

July 25, 2012

When we first started Lean in the Beavercreek Primary Care Clinic originally in 2009 we learned a very valuable lesson about implementing lean in a clinics setting in the first year. In fact it was first realized by a Lean Practitioner at the Behavioral Health Clinic.

She stated,”All areas of the clinic need to participate. You cannot work on process improvement in one area in the clinic, all areas in the clinic need to be involved. You cannot implement a change in one area of the clinic without it affecting all areas of the clinic.”

WOW!!!!!!!! It was a light bulb going on!!!!

We realized the following:

We did not have Lean practitioners from all areas of the Primary Care Clinic

We had to few, 4 Lean practitioners

We lost momentum when 2 of the lean practitioners left the clinic

Staff was hesitant to invest time and effort in LEAN, concerned that it would not stick.

In recent months, the clinic was reintroduced to LEAN in a more meaningful and carefully planned way. Staff have reportedly ‘changed’ their thinking on LEAN and begun to recognize the value of its philosophy, tools and techniques. What changed? Why did staff get engaged in LEAN again? What factors improve the success rate of adopting LEAN in a workforce?

First, an Improvement Team(8) was formed that includes representatives from all departments in the clinic such as Medical Records, Medical Assistants, Providers, Front Office and Dental.

At the first meeting, the team developed ground rules and expectations.

The team created a process for approving staff’s improvement ideas

Developed a communication plan for Lean updates to clinic management and staff.

Management strongly and visibly supports a Lean workforce.

Supervisors free up time for staff to attend meetings

Allows time to work on improvement projects.

-There still remains much work to be done.

The team’s projects are focused on improving the patient’s experience and ultimately their overall health and what’s more important than that?

July 10, 2012

When I read this article in the Columbian newspaper it could have been written about our efforts at H3S over the last 3 years. It is nice to know we are not alone in our efforts to introduce our Lean. The challenges other face implementing Lean process improvement are our challenges.

Lean Practices Paying Off for Medical Center

You’ve had those days at work: Your boss doesn’t listen to your suggestions about how to do things better. The same problems keep cropping up. Nobody does anything about them. New conundrums pile up. Your time, maybe even the company’s money, is wasted.

Rewind. Repeat. Pull hair.

Your savior? Lean. Not as in exercising to shed weight and stress, but as in embracing a way of doing business that cuts waste, boosts teamwork, systematically tracks and fixes problems, and recognizes hard work. It’s not a new concept. It doesn’t have a set definition. But “lean” management principles have taken root at Vancouver-based Legacy Salmon Creek Medical Center -- where the concept is saving time and tens of thousands of dollars a year.

Michael Boer, a process improvement engineer with Legacy said implementing lean practices isn’t about coming up with the perfect plan. It’s about planning and taking action, and then refining your approach as you go. Or, as he put it, “Let’s just give it a try.” The idea is to relentlessly improve the processes that lead to getting things done by standardizing how you complete tasks, setting benchmarks to measure success and failure, and relying on empirical data -- rather than intuition or pre-conceived notions -- to decide what does or doesn’t matter.

And lean, which has practical implications for workplaces, families and schools, also has leapt from the confines of manufacturers to hospitals. ThedaCare in Wisconsin is a leader. So is Virginia Mason Medical Center in Seattle. Legacy Salmon Creek Medical Center began looking at lean practices in January 2010 as hospital leaders recognized they lacked a systematic approach to monitoring work processes and improving them.

The program hinges on a three-pronged approach: leaders who “live” the hospital’s lean principles; “visual management boards,” where key performance indicators are posted, and green- and red-colored boxes show what’s working and what needs to be fixed; and huddles -- brief, periodic gatherings of leaders and employees around the visual management boards to make status checks and sort out ideas and issues.

Effective efforts

For example, the hospital has cut the time it takes to secure a bed for a patient who’s transferring out of the intensive-care unit by 50 percent. That’s enabled the hospital to more quickly move patients from the emergency department to the ICU.

And by gathering new information and using it in a more timely manner, the hospital’s food services staff have seen increases in customer satisfaction ratings and shorter wait times for customers.

Inside the hospital’s intensive-care unit, a visual management board includes more than just performance metrics, and green and red boxes. It also displays cards the staff has used to recognize good work. One of them spotlighted an employee who’d detected an abnormal reading on a heart monitor. “Good catch!” it read.